Sole Source Justification

RESEARCH PROJECT SUBCONTRACT
(Applies Only to Sub-Contracts with Private Sources)
in Excess of $10,000

SUB-CONTRACT EFFECTIVE ____/____/____ THROUGH ____/____/____

The Services described below are requested as a Sole Source Subcontract in connection with a research project at the University of Virginia.

NAME OF SUBCONTRACTOR:_______________________________________________

ADDRESS:________________________________________________________

ADDRESS:________________________________________________________

CONTACT PERSON:________________________________________________________

TELEPHONE #:________________________________________________________

I. Services Being Subcontracted:__________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

II. Reason(s) for Selecting This Subcontractor (Mention Other Subcontractors Considered and Reasons Not Selected, if Applicable):

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

(over)

8.9.13

7/15/92

                            AUTHORIZATION/APPROVALS


_______________________________________________________________
Department (Print or Type)

_______________________________________________________________
Name of Principal Investigator (Print or Type)

_______________________________________________________________
Signature                                   Date

_______________________________________________________________
Department Head (Print or Type)

_______________________________________________________________
Signature                                   Date

---------------------------------------------------------------
OFFICE OF SPONSORED PROGRAMS

_______________________________________________________________
Representative (Full Name and Title--Print or Type)

_______________________________________________________________
Signature                                   Date

---------------------------------------------------------------
PURCHASING AND MATERIALS SERVICES

_______________________________________________________________
Director/Chief Contracting Officer (Signature)       Date

__________________________________  ___________________________
Date Posted                          Posting Expires










8.9.14                                              7/15/92